Consent and Informed Consent: Their Ongoing Evolutions in Clinical Care and Research on Humans

The dual concepts of 'consent' and 'informed consent' continue to have three evolutions. The primary evolution of consent in the patient–physician relationship began in Great Britain in 1767 in the British case, Slater v. Baker and Stapleton , in the judge-made law of consent. The term 'informed consent' within the patient–physician relationship entered the judicial lexicon in the 1957 California appellate case, Salgo v. Leland Stanford Junior University . In its second evolution within research on humans following the Nuremberg trials that included experimental atrocities on humans, there is a key focus on clarifying the purpose of research and specifying the reasons for the need for an even more extensive risk disclosure to individuals considering volunteering for study participation. This second evolution continues with the further refinement of the Declaration of Helsinki and, within the USA, a focus on the Belmont Report . In its third evolution in research in the social science, there has been a recognition of problems with informed consent to questionnaire research. When questionnaires involve patients with moderate or severe posttraumatic stress disorder or abused individuals, there needs to be intense consideration focused on how to best protect the participants with these conditions during the questionnaire study.     

Ecocultural Attributes: Evaluating Ecological Degradation in Terms of Ecological Goods and Services Versus Subsistence and Tribal Values

It is becoming increasingly clear that scientists, managers, lawyers, public policymakers, and the public must decide how to value what is provided by, and is a consequence of, natural resources. While “Western” scientists have clear definitions for the goods and services that ecosystems provide, we contend that these categories do not encompass the full totality of the values provided by natural resources. Partly the confusion results from a limited view of natural resources derived from the need to monetize the value of ecosystems and their component parts. Partly it derives from the “Western” way of separating natural resources from cultural resources or values, and partly it derives from the false dichotomy of assuming that ecosystems are natural, and anything constructed by man is not natural. In this article, we explore the previous assumptions, and suggest that because cultural resources often derive from, and indeed require, intact and unspoiled natural ecosystems or settings, that these values are rightly part of natural resources. The distinction is not trivial because of the current emphasis on cleaning up chemically and radiologically contaminated sites, on restoration of damaged ecosystems, on natural resource damage assessments, and on long‐term stewardship goals. All of these processes depend upon defining natural resources appropriately. Several laws, regulations, and protocols depend upon natural resource trustees to protect natural resources on trust lands, which could lead to the circular definition that natural resources are those resources that the trustees feel they are responsible for. Where subsistence or tribal peoples are involved, the definition of natural resources should be broadened to include those ecocultural attributes that are dependent upon, and have incorporated, natural resources. For example, a traditional hunting and fishing ground is less valued by subsistence peoples if it is despoiled by contamination or physical ecosystem degradation; an Indian sacred ground is tarnished if the surrounding natural environment is degraded; a traditional homeland is less valued if the land itself is contaminated. Our argument is that intact natural resources are essential elements of many cultural resources, and this aspect requires and demands adequate consideration (and may therefore require compensation).     

Social and demographic determinants of abortion in Poland

Summary Most abortions in Polish hospitals and clinics are performed on social indications. In the 22 administrative areas of Poland, the high rates of divorce and large proportions of total population employed in non-agricultural pursuits reflect the individualistic approach to family planning which is characteristic of present-day urban society. Industrialization is disruptive to the normal functioning of the country's traditionally large families. In addition, the gross reproduction rate increases directly with the proportion of the peasant population in 17 voivodships and five large cities of Poland, whereas in the urban sector the gross reproduction rate has fallen below replacement level in the past few years. Rural birth rates will continue to decline. In view of increasing needs for future manpower, population policy aimed at increasing births through incentives to prospective mothers may achieve a limited degree of success in cities only among the educated segments of the female population.     

Lessons from Nigeria for improved thinking and working politically in the extractives sector

Despite the wealth that comes from being the biggest oil producer in Africa, Nigeria has some of the worst development indicators in the world. From 2011 to mid‐2016, the DFID‐funded Facility for Oil Sector Transparency and Reform (FOSTER) programme's unique design aimed to reduce incentives for the capture of oil revenue by elites and international oil companies, restoring the potential of those revenues to accelerate economic and social development. This article asks what lessons FOSTER's successes and failures offer for improved “thinking and working politically” (TWP). It examines the outcomes from five “clusters” of interventions: three viewed by the FOSTER team as successes and two as failures. The article identifies factors for successful TWP‐based programming, including the need for local ownership rooted in staff with a combination of technical expertise, a deep knowledge of the local political context and excellent networking abilities. The research used a qualitative and inductive approach. Field research was undertaken with 44 semi‐structured qualitative interviews during one month of fieldwork in Abuja and Lagos. The research also included reviews of FOSTER's internal documentation and evaluation frameworks, as well as analysis of newspaper articles and grey literature on the oil sector in Nigeria. The project offers important lessons for politically informed programming about how interventions were implemented (process), what was actually done (content) and how the project responded to changes in context that created or blocked opportunities for reform (responsiveness). The article identifies factors for successful TWP‐based programming, including the need for local ownership rooted in staff with a combination of technical expertise, a deep knowledge of the local political context and excellent networking abilities. The findings have important implications for programme design. They demonstrate the value of built‐in flexibility that allows staff to choose and switch the partners they work with and the channels they work through. They also show that a key aspect of TWP‐based programming is implicit acceptance that some failure may be unavoidable, since this permits staff to balance risk against opportunities. Finally, a better understanding of FOSTER's failures reveals the challenges of a TWP‐based approach and the trade‐offs it demands.     

Changes in risky gambling prevalence among a New Zealand population cohort

Evidence suggests that problem gambling is an unstable state where gamblers move into and out of risk over time. This article looks at longitudinal changes in risky gambling and the factors associated with an increased risk (measured by the Problem Gambling Severity Index [PGSI]) in the current New Zealand context, which has experienced a doubling of the electronic gaming machine (EGM) market over the last two decades. Respondents from a nationally representative baseline sample (n = 2672) were recontacted two years later to assess changes in gambling behaviours. Among the 901 respondents reached at follow-up, average gambling risk increased over time, and the prevalence of those who had at least some level of gambling risk (i.e. low-risk or greater) more than doubled (from 4.7% to 12.4%). The majority (80.2%) of those who were at risk at follow-up had not been at risk at baseline. Multivariate linear regression analyses show that the predictors of low to moderate increased risk include Pacific ethnicity; high neighbourhood deprivation status; baseline frequent, continuous gambler type; baseline PGSI status; and playing EGMs. These findings highlight the need to develop theories of gambling addiction trajectories and to identify the earliest point along the trajectory where public health interventions should occur.     

Vocational education,self‐employment and burnout among Australian workers

We examine the relationship between vocational education and occupational burnout among workers in different forms of employment. Although the self‐employed enjoy higher levels of job autonomy and work‐related satisfaction, we do not know whether they experience lower rates of occupational burnout, and whether vocational education plays a role in this relationship. This latter consideration is important, given that vocational qualifications often lead to self‐employment and prior research demonstrated that formal training may reduce burnout. However, formal education was previously measured in years of schooling, without considering the distinction between academically‐oriented and vocational courses. Therefore, using data from a 2001 national survey of working Australians, we first establish that the self‐employed are significantly less likely to experience burnout. We then demonstrate that some resilience to burnout can be attributed to the attainment of skilled vocational training, net of employment characteristics which are also very important.